Rates Of Preeclampsia Research Articles

Preeclampsia Prevalence, Risk Factors, and Pregnancy Outcomes in Sweden and China

Preeclampsia is a leading cause of maternal and perinatal morbidity and mortality worldwide. Within-country studies have reported racial differences in the presentation and outcome, but little is known about differences between countries. To compare preeclampsia prevalence, risk factors, and pregnancy outcomes between the Swedish and Chinese populations. This cross-sectional study compared deliveries from the Swedish national Medical Birth Register (2007-2012) and the China Labor and Delivery Survey (2015-2016). The Swedish Medical Birth Register records maternal, pregnancy, and neonatal information for nearly all deliveries in Sweden. The China Labor and Delivery Survey was conducted throughout China, and these data were reweighted to enable national comparisons. Participants included 555 446 deliveries from Sweden and 79 243 deliveries from China. Data management and analysis was conducted from November 2018 to August 2020 and revised in February to March 2021. Maternal characteristics, parity, multiple gestation, chronic and gestational diabetes, cesarean delivery. Preeclampsia prevalence and risk factors, overall and for mild and severe forms and rates of adverse neonatal outcomes compared with pregnancies with no gestational hypertension. The 555 446 Swedish pregnancies and 79 243 Chinese pregnancies had mean (SD) maternal age of 30.9 (5.3) years and 28.6 (4.6) years, respectively. The overall prevalence of preeclampsia was similar in Sweden and China, 16 068 (2.9%) and 1803 (2.3%), respectively, but with 5222 cases (32.5%) considered severe in Sweden and 1228 cases (68.1%) considered severe in China. Obesity (defined as BMI ≥28 in China and BMI ≥30 in Sweden) was a stronger risk factor in China compared with Sweden (China: odds ratio [OR], 5.12; 95% CI, 3.82-6.86; Sweden: OR, 3.49; 95% CI, 3.31-3.67). Nulliparity had a much stronger association with severe preeclampsia in Sweden compared with China (Sweden: OR, 3.91; 95% CI, 3.65-4.18; China: OR, 1.65; 95% CI, 1.20-2.25). The overall stillbirth rate for singleton in China was more than 3-fold higher than in Sweden (846/77 512[1.1%] vs 1753/547 219 [0.3%], P < .001), and 10-fold higher among women with preeclampsia (66/1652 [4.6%] vs 60/14 499[0.4%], P < .001). In this study, the prevalence rates of preeclampsia in Sweden and China were similar, but women in China had more severe disease and worse pregnancy outcomes than women in Sweden. The associations of obesity and nulliparity with preeclampsia suggest a role for lifestyle and health care factors but may reflect some differences in pathophysiology. These findings have relevance for current efforts to identify high-risk pregnancies and early serum markers because the value of risk prediction models and biomarkers may be population specific.

Incidence and risk factors for severe preeclampsia, hemolysis, elevated liver enzymes, and low platelet count syndrome, and eclampsia at preterm and term gestation: a population-based study

The majority of previous studies on severe preeclampsia, eclampsia, and hemolysis, elevated liver enzymes, and low platelet count syndrome were hospital-based or included a relatively small number of women. Large, population-based studies examining gestational age-specific incidence patterns and risk factors for these severe pregnancy complications are lacking. This study aimed to assess the gestational age-specific incidence rates and risk factors for severe preeclampsia, hemolysis, elevated liver enzymes, and low platelet count syndrome, and eclampsia. We carried out a retrospective, population-based cohort study that included all women with a singleton hospital birth in Canada (excluding Quebec) from 2012 to 2016 (N=1,078,323). Data on the primary outcomes (ie, severe preeclampsia, hemolysis, elevated liver enzymes, and low platelet count syndrome, and eclampsia) were obtained from delivery hospitalization records abstracted by the Canadian Institute for Health Information. A Cox regression was used to assess independent risk factors (eg, maternal age and chronic comorbidity) for each primary outcome and to assess differences in the effects at preterm vs term gestation (<37 vs ≥37 weeks). The rates of severe preeclampsia (n=2533), hemolysis, elevated liver enzymes, and low platelet count syndrome (n=2663), and eclampsia (n=465) were 2.35, 2.47, and 0.43 per 1000 singleton pregnancies, respectively. The cumulative incidence of term-onset severe preeclampsia was lower than that of preterm-onset severe preeclampsia (0.87 vs 1.54 per 1000; rate ratio, 0.57; 95% confidence intervals, 0.53-0.62), the rates of hemolysis, elevated liver enzymes, and low platelet count syndrome were similar (1.32 vs 1.23 per 1000; rate ratio, 0.93; 95% confidence interval, 0.86-1.00), and the preterm-onset eclampsia rate was lower than the term-onset rate (0.12 vs 0.33 per 1000; rate ratio, 2.64; 95% confidence interval, 2.16-3.23). For each primary outcome, chronic comorbidity and congenital anomalies were stronger risk factors for preterm- vs term-onset disease. Younger mothers (aged <25 years) were at higher risk for severe preeclampsia at term and for eclampsia at all gestational ages, whereas older mothers (aged ≥35 years) had elevated risks for severe preeclampsia and hemolysis, elevated liver enzymes, and low platelet count syndrome. Regardless of gestational age, nulliparity was a risk factor for all outcomes, whereas socioeconomic status was inversely associated with severe preeclampsia. The risk for severe preeclampsia declined at term, eclampsia risk increased at term, and hemolysis, elevated liver enzymes, and low platelet count syndrome risk was similar for preterm and term gestation. Young maternal age was associated with an increased risk for eclampsia and term-onset severe preeclampsia. Prepregnancy comorbidity and fetal congenital anomalies were more strongly associated with severe preeclampsia, hemolysis, elevated liver enzymes, and low platelet count syndrome, and eclampsia at preterm gestation.

The correlation between maternal age, parity, cardiac diastolic function and occurrence rate of pre-eclampsia

To evaluate the effect of age and parity on maternal cardiac diastolic function in second trimester among pregnant women with normal left ventricular ejection fraction. To analyze the correlation between impaired diastolic function and pre-eclampsia. It had been suggested that maternal cardiac adaptations during pregnancy differed between nulliparous and primiparous women and also varied according to age. Impaired cardiac function may precede pre-eclampsia. Therefore, we examined the effects of parity and age on cardiac diastolic function during pregnancy and whether impaired diastolic function during the second trimester correlates with pre-eclampsia. Women with singleton pregnancies at 13 + 0 to 27 + 6 weeks’ gestation and left ventricular ejection fraction (LVEF) ≥ 50% were retrospectively identified. Diastolic function parameters were assessed using transthoracic echocardiography. Pre-eclampsia was identified from medical records. The effect of age and parity on maternal cardiac diastolic function as well as the correlation between impaired diastolic function and occurrence rate of pre-eclampsia were examined. 376 pregnant women were included (median age: 30 years; median gestational age: 14 weeks; 171 primiparous women). LVEF was 66%. Impaired cardiac diastolic function was seen in 7.8% of pregnant women < 35 years compared with 28.6% of those ≥ 35 years (p = 0.000). ROC curve showed women with maternal age over 32 began to have a higher rate of impaired cardiac diastolic function (AUC = 0.704, p = 0.000, sensitivity = 54.5%, specificity = 75.3%). There was no difference in diastolic function indices between maternal women grouped by parity. Higher maternal age was an independent risk factor of declining Em (p < 0.05). Em < 13 cm/s was significantly associated with pre-eclampsia occurrence (HR 8.56; 95% CI 3.40–21.57) after being adjusted for confounders. Maternal age is an independent risk factor for diastolic function decline. There is no difference in cardiac diastolic function between nulliparous women and primiparous women. Pre-eclampsia occurrence is significantly higher in patients with impaired diastolic function at mid-gestation. The application of risk grading using diastolic function at mid-gestation may improve the survival outcomes of pregnant women.

Gebelik ve Doğum Sonu Dönemde Preeklampsi Yaşayan Hastanın Yaşam Aktiviteleri Modeli’ne Göre Hemşirelik Bakımı: Olgu Sunumu

Preeklampsi, gebelik ve doğum sonu dönemde anne ve bebek sağlığını ciddi şekilde etkileyecek önemli bir sağlık sorunudur. Dünyada anne ve bebek ölümlerinin nedenleri arasında preeklampsi ön sırada yer almaktadır. Gebelik döneminde hipertansiyon hastalıklarının arasında yer alan preeklampsi önemli bir gebelik komplikasyonudur. Ancak preeklampsinin erken tespit edilerek doğru yönetilmesi ile maternal morbidite ve mortalite oranları azaltılabilmektedir. Bu çalışmada, yüksek riskli gebelik servisinde preeklampsi tanısı ile yatan hastanın bütüncül ve sistematik hemşirelik bakım sürecinin değerlendirilmesi hedeflenmiştir. Sağlık profesyonellerinin, gebeleri preeklampsi bulgu ve belirtileri hakkında bilgilendirmesi ve mevcut bir hastalık belirtisinde sağlık kuruluşu ile temasa geçmesinin aciliyetini vurgulaması gerekmektedir. Hemşirelik bakım sürecinde model kullanımının gerekliliğini vurgulamak ve uygulama alanında kullanılmasını sağlamak amacıyla Roper, Logan ve Tierney tarafından geliştirilen Yaşam Aktivitelerine temelli Hemşirelik Modeli kullanılarak preeklampsi olgusu değerlendirilmiştir.

Clinical risk factors for preeclampsia in twin pregnancies.

BackgroundPreeclampsia is a common obstetric complication. The rate of preeclampsia is increased in twin pregnancies. The aim of this study was to assess the clinical risk factors for developing preeclampsia in twin pregnancies.MethodsA case-control study was carried out among women with twin pregnancies who delivered at gestational age more than 23 weeks at King Chulalongkorn Memorial Hospital, Department of Obstetrics and Gynecology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand, from 2003 to 2019. The data were retrieved from electronic medical records. Multivariate logistic regression analysis was used to find the risk factors.ResultsA total of 1,568 twin pregnancies were delivered during the study period and 182 cases (11.6%) developed preeclampsia. 172 cases with preeclampsia and 516 controls were selected for analysis. After certain variables were adjusted in the multivariate logistic regression analysis, the clinical factors associated with preeclampsia in twin pregnancies were nulliparity (adjusted odds ratio (OR) 1.57, 95% confidence interval (CI) 1.02–2.41) and chronic hypertension (adjusted OR 6.22, 95%CI 1.98–19.57). Low gestational weight gain was a significant protective factor against the development of preeclampsia (adjusted OR 0.50; 95%CI 0.32–0.77).ConclusionThe clinical risk factors for developing preeclampsia in twin pregnancies were nulliparity and chronic hypertension. These risk factors are of value to identify twin pregnant women at risk for preeclampsia and in implementing primary prevention.

Frequency of ABO Blood Group in Pregnant Women and Its Correlation With Pregnancy-Related Complications

IntroductionThe ABO blood group type has been considered an independent risk factor in the occurrence of pregnancy-related complications leading to significant morbidity and mortality in pregnant mothers and neonates. This study aims to determine the maternal ABO blood group and its correlation with pregnancy-related complications.MethodsWe analysed data of 497 pregnant female patients aged between 25 and 40 years who presented with a gestational age of > 14 weeks from June 1, 2020, to November 30, 2020. Patients’ age, parity, gestational age at the first visit, body mass index (BMI) at the first visit, ABO blood group, gestational age at delivery, mode of delivery, birth weight of neonate, and pregnancy-related complications including preeclampsia, gestational diabetes mellitus (GDM), preterm delivery, low birth weight (LBW), and small for gestational age (SGA) infants were evaluated.ResultsThe mean age of 497 patients was 27.6 (27.62 ± 3.35) years. Mean BMI was 22.7 (22.7 ± 3.1 kg/m2), parity was 1.85 (1.85 ± 2.3), gestational age at first visit was 23.19 (23.19 ± 3.4) weeks and gestational age at delivery was 37.0 (37.0 ± 2.6) weeks. There were 205 (41.25%) spontaneous vaginal delivery and 292 (58.75%) cesarean sections. The average birth weight of the neonate was 2684.31 ± 622.4 g. Preeclampsia was observed in 107 (21.53%), GDM in 17 (3.42%), and preterm delivery in 154 (30.99%) women. Considering the neonatal outcome, 124 (24.95%) babies had LBW and 49 (9.86%) were SGA. The rate of preeclampsia and GDM was not statistically significant among different blood groups while the rate of preterm delivery, LBW, and SGA was significant among women with different blood groups.ConclusionWe conclude that the ABO blood group is associated with maternal and neonatal pregnancy-related complications when considering the risk of preterm delivery, LBW, and SGA but not with GDM and preeclampsia. This finding will help clinicians to identify the patients at risk of developing pregnancy-related complications and hence, to take timely and appropriate measures.

The Effects of Pre-Pregnancy Body Mass Index and Weight Gain During Pregnancy on Perinatal Outcomes: A Retrospective Cohort Study

OBJECTIVE: To investigate the effects of pre-pregnancy body mass index and weight gain during pregnancy on perinatal outcomes and delivery mode. STUDY DESIGN: In this retrospective cohort study, 722 pregnant women giving birth between 2018-2019 were screened from our hospital database. First, they were divided into four groups according to their pre-pregnancy body mass index (low-weight/normal-weight/overweight/obese), and then they were redivided into three groups according to pregnancy weight gain (≤7/8-15/≥16 kg). Prenatal body mass index and pregnancy weight gain were compared concerning maternal-neonatal results and mode of delivery. RESULTS: According to pre-pregnancy body mass index, among the obese pregnant group, gestational diabetes mellitus (p&lt;0.001), preeclampsia (p=0.029), preterm delivery (p=0.011) and cesarean delivery (p=0.061) rates were more common. As the body mass index increases, neonatal intensive care requirement (p=0.0020) and low 1st minute APGAR scores (p=0.019) were detected more frequently. However, as pregnancy weight gain decreased, preterm delivery (p=0.041) increased. Also, birth weight increased (p&lt;0.001) with the weight gain of the pregnant. Pregnant women gaining more than 16 kg were associated either with a lower &lt;2500 g or a higher birth weight risk &gt;4000 g. CONCLUSION: Pre-pregnancy high body mass index is associated with negative obstetric outcomes like gestational diabetes, preeclampsia, preterm delivery, and increased cesarean rates, and poor fetal incidences with a low APGAR score and high neonatal intensive care admission rates.

Comparison of maternal and neonatal outcomes between acute fatty liver of pregnancy and hemolysis, elevated liver enzymes and low platelets syndrome: a retrospective cohort study

BackgroundAcute fatty liver of pregnancy (AFLP) and hemolysis, elevated liver enzymes and low platelets (HELLP) syndrome are two uncommon disorders that mimic each other clinically, but are distinct pathophysiologically. This study aimed to compare maternal and neonatal outcomes between AFLP and HELLP syndrome.MethodsThis retrospective cohort study was performed at a tertiary referral center in Taiwan between June 2004 and April 2020. We used the Swansea Criteria to diagnose AFLP, and the Tennessee Classification System to diagnose HELLP syndrome. Maternal characteristics, laboratory data, complications, and neonatal outcomes were compared. We analyzed the categorical variables with Chi-square test or Fisher’s exact test and continuous variables with Student’s t test or Mann-Whitney U test. Subsequent logistic regression analyses adjusting by potential confounding factors with significant difference were analyzed.ResultsDuring the study period, 21 women had AFLP and 80 women had HELLP syndrome. There was a higher rate of preeclampsia (95.0 % versus 23.8 %) in the HELLP syndrome group compared to the AFLP group. However, the AFLP group had more other maternal complications including jaundice (85.7 % versus 13.8 %), acute kidney injury (61.9 % versus 15.0 %), disseminated intravascular coagulopathy (66.7 % versus 8.8 %), and sepsis (47.6 % versus 10.0 %) compared to the HELLP syndrome group. Nevertheless, higher rates of small for gestational age neonates (57.1 % versus 33.3 %), neonatal respiratory distress syndrome (39.2 % versus 8.3 %) and neonatal sepsis (34.2 % versus 12.5 %) were noted in the HELLP syndrome group.ConclusionsAFLP is associated with a higher rate of multiple organ dysfunction in mothers, whereas HELLP syndrome is associated with a higher rate of neonatal morbidity.

Risk factors for pregnancy morbidity in women with antiphospholipid syndrome

Antiphospholipid syndrome (APS) increases the risk of obstetric complications, but risk factors for pregnancy morbidity in women with APS remain incompletely characterized. This retrospective study included pregnant women with APS and a control group without APS admitted to Peking University People’s Hospital between January 2013 and September 2019. Clinical data were extracted from medical records. Univariate and multivariate logistic regression analyses were used to identify factors associated with adverse pregnancy outcomes (fetal loss, premature birth, fetal growth restriction [FGR], preeclampsia and neonatal death). We included 64 pregnancies in 59 patients with APS (age, 32.3 ± 4.3 years) and 256 pregnancies in 256 women without APS (age, 30.4 ± 3.3 years). Compared with the control group, the APS group had higher incidence rates of preeclampsia (10.9 % vs. 2.3 %, P = 0.002), premature rupture of membranes (17.2 % vs. 3.9 %, P < 0.001), postpartum hemorrhage (23.4 % vs. 4.3 %, P < 0.001), fetal loss (4.7 % vs. 0.8 %, P = 0.024) and premature delivery at ≤34 weeks (7.8 % vs. 2.3 %, P = 0.047). The incidence rates of hypertension during pregnancy, HELLP syndrome, gestational diabetes, oligohydramnios and FGR were similar in both groups. Multivariate logistic regression revealed that three or more prior spontaneous miscarriages (odds ratio [OR], 6.162; 95 % confidence interval [CI], 1.271–29.882; P = 0.024) and double-positivity for antiphospholipid antibodies (OR, 4.024; 95 %CI, 1.025−15.794; P = 0.046) were independently associated with adverse pregnancy outcomes. APS increases the risks of adverse maternal and fetal outcomes during pregnancy. Three or more spontaneous miscarriages and double-positivity for antiphospholipid antibodies are risk factors for adverse pregnancy outcomes in women with APS.

COVID-19 під час вагітності. Аналітичний огляд

The cause of the current pandemic was the rapid spread of the coronavirus SARS-CoV-2 and the development of respiratory syndrome with significant morbidity and mortality. Pregnant women have the higher risk of morbidity and mortality than non-pregnant women. Pregnancy is the vulnerable condition that may contribute to a higher risk of infection due to the change in physiology during gestation. Physiologic, metabolic, and vascular changes in normal and high-risk pregnancies may affect risks for severe acute respiratory syndrome SARS-CoV-2 infection. The pathogenesis of COVID-19 during pregnancy explains the functioning of the renin-angiotensin-aldosterone system. SARS-CoV-2 uses angiotensin-converting enzyme-2 receptors to enter target cells. Its regulation during pregnancy may increase the risk of respiratory syndrome with COVID-19. The virus, by binding to receptors, causes decreasing its regulation and can lead to increasing angiotensin II, relative to angiotensin 1, 7, which is manifested by vasoconstriction and vascular dysfunction in preeclampsia. Coronavirus disease and preeclampsia have partially the same pathophysiological mechanism, which includes endothelial dysfunction and coagulation disorders. There is systemic inflammation or microcirculation disorders, which is characterized by vasoconstriction and ischemia, hypercoagulation. Thus, abnormalities that are characteristic of COVID-19 infection are similar to those that occur with preeclampsia during pregnancy. In addition, the known pathological mechanism of COVID-19 is an excessive anti-inflammatory response called the cytokine storm. The immune response is sufficiently altered during pregnancy, which can significantly alter the laboratory and clinical manifestations of COVID-19 during pregnancy. Therefore, the combination of these conditions can potentially lead to vascular damage. Currently, there are very limited data on the course, clinic and consequences of infection during pregnancy. This literature review combines various high-level studies that indicate higher rates of preeclampsia and other complications associated with pregnancy and SARS-CoV-2 infection. Studies to date have reported higher risks of pregnancy complications, including preterm birth and preeclampsia, as well as higher rates of cesarean delivery. For the fetus were recorded isolated cases of stillbirth, which was less than &lt;1%. Accordingly, this signals needs to increase attention to the course of infection during pregnancy, and the optimal treatment of COVID-19, as well as prevention strategies during pregnancy. Pharmacologic therapy is limited to medications with proven safety during pregnancy and lactation. No conflict of interest was declared by the authors. Key words: COVID-19, pregnancy, newborns, pregnancy complications.

Should the interval between doses of antenatal corticosteroids be shortened in certain cases? Factors predicting preterm delivery < 48h from presentation.

Treatment with antenatal corticosteroids (ACS) to women at risk for preterm birth (PTB) is associated with a reduction in adverse neonatal outcomes. Obstetricians occasionally shorten the interval between the doses of steroids if delivery is predicted to occur before ACS are fully administered. In this study, we aimed to investigate predicting factors to identify patients that will deliver prematurely, less than 48h from presentation. The computerized medical files of all PTBs (< 34weeks) were reviewed. Maternal demographics, pregnancy and delivery characteristics were compared between PTB that occurred < 48h vs. > 48h from triage presentation. In total, 494 PTB cases were included: 302 women in the study group (PTB < 48h) and 192 women in the control group (PTB > 48h). No significant differences were found in demographic characteristics between the groups. At presentation, the study group had higher rates of uterine contractions (p < 0.001) and cervical length < 25mm (p < 0.001) as well as a higher rate of non-reassuring fetal (NRFHR) monitor (p < 0.001). In contrast, the control group presented with higher rates of preeclampsia (p = 0.003) and preterm premature rupture of membranes (p = 0.038). In multivariable analysis, all of the above factors remained significant after controlling for background confounders. Various factors at presentation can predict delivery < 48h. These factors can be used to predict patients to whom the ACS interval should be shortened. Future prospective studies should investigate the effect of this shortening on neonatal outcomes.

Association of higher HbA1c within the normal range with adverse pregnancy outcomes: a cross-sectional study.

The aim of this study was to investigate the association between a relatively high HbA1c level within the normal range and the risk of adverse pregnancy outcomes. This retrospective cohort study was conducted between March 2018 and March 2019 at Women's Hospital, School of Medicine, Zhejiang University. Multiple logistic regression models after adjusting for plausible confounders were implemented to assess the relationships between the level of HbA1c and adverse pregnancy outcomes. A total of 8585 women were included in our study. The rates of preterm birth, macrosomia and preeclampsia were 4.4% (380/8585), 5.3% (457/8585) and 1.7% (149/8585), respectively. After adjusting for potential confounding variables, an HbA1c range of 5.5-5.9% (37-41mmol/mol) remained significantly associated with an increased risk of preterm delivery (a-OR 2.27; 95% CI, 1.50-3.43), macrosomia (a-OR 1.97; 95% CI, 1.32-2.94) and preeclampsia (a-OR 3.70; 95% CI, 2.07-6.60). GDM-negative pregnant women with an HbA1c level in the range of 5.5-5.9% (37-41mmol/mol) had an increased risk of preterm delivery (a-OR 2.84; 95% CI, 1.71-4.71) and preeclampsia (a-OR 3.82; 95% CI, 1.81-8.04). However, GDM-positive pregnant women had an increased risk of macrosomia (a-OR 2.12; 95% CI, 1.13-3.97) and preeclampsia (a-OR 2.62; 95% CI, 1.01-6.81). A higher HbA1c level within the normal range is an independent risk factor for preterm delivery and preeclampsia, especially among GDM-negative women. Therefore, relevant medical staff should enhance the awareness of risk and prevention to strengthen pregnancy monitoring.

Pregnancy and Systemic Lupus Erythematosus in Spain: Has Anything Changed in the 21st Century?

To analyse a cohort of pregnant patients with systemic lupus erythematosus and compare the outcomes of both the disease and pregnancy with the results of previous studies conducted in the same geographical area. Retrospective cohort study of 37 women with systemic lupus erythematosus (64 pregnancies) followed in a multidisciplinary unit. Comparative study with similar Spanish studies identified after literature search. Our cohort was characterized by an older age and by the presence of non-Caucasian patients. Although we found no clinical differences, from the serological point of view our cohort presented a higher frequency of antiphospholipid antibodies. Patients included in this study were treated more frequently with antimalarials and low-dose aspirin. Systemic lupus erythematosus flare frequency was very similar between the different studies, and we did not identify clear predictors for them. Although the rate of live births was similar among studies, the obstetric outcome of our series was better with a very low rate of preeclampsia, preterm birth and low birth weight newborn. The only predictor of adverse obstetric event was age. Although changes in the therapeutic attitude and planning of pregnancy in recent years have not had a direct impact on the rate of systemic lupus erythematosus flares during pregnancy, they have meant an improvement in the obstetric results. The introduction of new variables independent of the disease such as age at conception, socio-cultural origin, or the availability of multidisciplinary units should be considered in the results of future studies.

Pregnancy and systemic lupus erythematosus in Spain: Has anything changed in the 21st century?

ObjectiveTo analyse a cohort of pregnant patients with systemic lupus erythematosus and compare the outcomes of both the disease and pregnancy with the results of previous studies conducted in the same geographical area. Patients and methodsRetrospective cohort study of 37 women with systemic lupus erythematosus (64 pregnancies) followed in a multidisciplinary unit. Comparative study with similar Spanish studies identified after literature search. ResultsOur cohort was characterized by an older age and by the presence of non-Caucasian patients. Although we found no clinical differences, from the serological point of view our cohort presented a higher frequency of antiphospholipid antibodies. Patients included in this study were treated more frequently with antimalarials and low-dose aspirin. Systemic lupus erythematosus flare frequency was very similar between the different studies, and we did not identify clear predictors for them. Although the rate of live births was similar among studies, the obstetric outcome of our series was better with a very low rate of preeclampsia, preterm birth and low birth weight newborn. The only predictor of adverse obstetric event was age. ConclusionsAlthough changes in the therapeutic attitude and planning of pregnancy in recent years have not had a direct impact on the rate of systemic lupus erythematosus flares during pregnancy, they have meant an improvement in the obstetric results. The introduction of new variables independent of the disease such as age at conception, socio-cultural origin, or the availability of multidisciplinary units should be considered in the results of future studies.

The diagnosis of Gestational Diabetes Mellitus and its impact on In Vitro Fertilization pregnancies. A pilot study.

In Vitro Fertilization (IVF) is increasingly becoming a necessary mode of reproduction. This high risk group is prone to Gestational Diabetes Mellitus (GDM) which further exposes these pregnancies to an increased risk of adverse outcomes. In light of the limited data in the current literature, further investigation is needed regarding the time of GDM diagnosis in IVF pregnancies as well as the outcome of IVF pregnancies complicated by GDM. In this three center pilot cross sectional study, the data of 101 singleton IVF pregnancies complicated by GDM were analyzed. Prompt GDM diagnosis in IVF pregnancies was accomplished by self-blood glucose monitoring (SMBG) from the first antenatal visit and confirmed by an OGTT. To evaluate pregnancy outcome, maternal and fetal complications in the 101 GDM IVF group was compared to 101 IVF as well as 101 spontaneous conceptions (SC). The three groups were matched by age. The effect of demographic and glycemic parameters on the outcome of GDM IVF pregnancies was investigated. GDM diagnosis was made before the 24th week in 37.6% of the GDM IVF group. The week of delivery was earlier for the GDM IVF group (37 ± 1.7) relative to the IVF (37.9 ± 0.9, p < 0.001) and the SC group (38.1 ± 0.8, p < 0.001). GDM IVF pregnancies exhibited greater preeclampsia rates and 84.8% underwent caesarian section. No significant difference regarding LGA and SGA birth weights was found. Complications of GDM IVF pregnancies were associated with the 1-h postprandial BG (r = 0.267, p = 0.007). GDM screening in IVF pregnancies may be considered earlier than the 24th week. IVF pregnancies affected by GDM are prone to increased maternal and fetal complications which are associated with 1-h postprandial BG.

Risk Factors Of Preeclampsia Among Pregnant Women In Indonesia

Preeclampsia is the second highest cause of maternal death in Indonesia. The incidence of preeclampsia in Indonesia is very high at 24%. West Java is a province in Indonesia with a high preeclampsia rate of 25%. Predisposing factors include preeclampsia including age. Health Research Data (2010) shows that the percentage of early marriage aged &lt;20 years is still high at 46.7% and marriage age&gt; 35 years at 0.6%. Objectives This study aims to determine the relationship between age and the incidence of preeclampsia at Dustira Hospital in Cimahi City. This study was conducted using the correlation with the case control approach. The population in this study was 130 postpartum mothers treated at Dustira Level II Hospital. The sampling technique used purposive sampling with a total of 24 for the preeclampsia group and 24 for the non-preeclampsia group. The data collected is secondary data collected by observing the medical record book. The research instrument uses a checklist sheet. The study was conducted in June 2019 at Dustira City II Kindergarten Hospital Cimahi. Univariate analysis uses frequency distribution and bivariate uses chi-square. Univariate test results showed that the incidence of preeclampsia was mostly experienced by pregnant women with age at risk of 58.3%. Bivariate test results showed a p value of 0.007 (α &lt;0.05) and OR 7 (95% CI: 1.822-26.887) meaning that there was a relationship between age and the incidence of preeclampsia, and mothers with age at risk had 7 times greater occurrence of preeclampsia compared to age is not at risk. Pregnant women aged less than 20 years or more than 35 years are at high risk of experiencing preeclampsia. One of the efforts to prevent the occurrence of preeclampsia is through health promotion about the age of mothers who are safe to reproduce. It is expected that health workers, especially maternity nurses, can provide health services to the public regarding the ideal age for pregnancy or childbirth as well as the age at risk of preeclampsia.&#x0D; &#x0D; Keywords: Indonesia, Maternal age pregnancies, Preeclampsia

A102 ADVERSE PREGNANCY-RELATED OUTCOMES IN WOMEN WITH INFLAMMATORY BOWEL DISEASE

Abstract Background Women with active inflammatory bowel disease (IBD) are at increased risk of adverse pregnancy outcomes such as preeclampsia. Though aspirin prophylaxis is prescribed in the general population (prior to 16 weeks’ gestation) for those at high-risk of preeclampsia, its use in patients with IBD has not been established. Aims To determine the frequency of and risk factors for adverse pregnancy outcomes in women with IBD, and to evaluate the risk for preeclampsia and the use of aspirin for primary prevention. Methods All pregnant women with IBD (Crohns disease (CD), ulcerative colitis (UC) and IBD-unclassified (IBDU)) seen at Mount Sinai Hospital from 2016–2020 were retrospectively identified. Demographics, reproductive history, and IBD characteristics including therapy and activity during pregnancy were recorded. Adverse pregnancy outcomes were also identified. Active disease during pregnancy was defined as a fecal calprotectin &amp;gt; 250 ug/g and/or using clinical disease activity scores. Categorical variables were compared using the Chi-square (x2) test and continuous variables using the Mann-Whitney test. A two-sided p-value less than 0.05 was considered statistically significant. Results 127 patients (66 with CD, 60 with UC, 1 with IBDU) were included with a median age of 32 years at conception. The majority were Caucasian (70.9%), married (82.7%), completed post-secondary education (69.3%), had no prior or current smoking (78.7%) or alcohol use history (67.7%), and had no other comorbidities (81.9%). 50.4% of women had a prior pregnancy. 3 had a history of preeclampsia and 15/127 were prescribed aspirin prophylaxis. 73.2% of women were in clinical remission at conception. Compared to women with CD, women with UC were more likely to have infants with low birth weight (LBW) (p=0.031), small for gestational age (SGA) (p=0.002) and had higher rates of active IBD during pregnancy (p=0.005). 13 women with IBD developed preeclampsia (6 with UC and 7 with CD). IBD type (p=0.844) and disease activity (p=0.308) were not associated with preeclampsia. Married women (p=0.001) while those who had a preconception consultation (50/127) (p=0.009) had lower rates of preeclampsia while those with a prior history of preeclampsia had higher rates (p=0.002). Among women who developed preeclampsia, pregnancy outcomes were comparable to those who did not. Women on aspirin prophylaxis (5/13) had a higher rate of preeclampsia (p=0.012), although they were also more likely to have a history of preeclampsia (p=0.002). Aspirin use was not associated with subsequent disease activity in pregnancy (p=0.830). Conclusions Women receiving aspirin prophylaxis had higher rates of preeclampsia, likely owing to a higher baseline risk. Preeclampsia prevention with aspirin prophylaxis does not appear to result in disease flares but larger studies are needed to confirm this finding. Funding Agencies None

A185 THE IMPACT OF PRIOR SURGERY ON ADVERSE PREGNANCY OUTCOMES IN PREGNANT PATIENTS WITH INFLAMMATORY BOWEL DISEASE

Abstract Background During the course of inflammatory bowel disease (IBD), approximately 20% of patients with ulcerative colitis (UC) and 80% of Crohn’s disease (CD) patients will require surgery. The most common operation is total proctocolectomy and ileoanal pouch anastomosis (IPAA) for UC patients and ileocecal (IC) resection for CD. In pregnant IBD patients, guidelines name the presence of IPAA as a relative indication for Cesarean section (C-section). The effect of prior IBD-related surgery on mode of delivery and pregnancy-related outcomes remains unknown. Aims To describe pregnancy-related outcomes in pregnant women with IBD who have undergone prior IBD-related surgery. Methods We performed a retrospective cohort study of pregnant women with IBD including those with prior IBD-related surgeries including IPAA, IC resection, total or partial colectomy and ileostomy formation who delivered an infant at our medical center from 2016 to 2020. We assessed the mode of delivery, delivery characteristics (emergency vs. planned C-section) and maternal and neonatal outcomes Results Fifty-six UC patients and 64 CD patients were included in the analysis, of which 10 and 24 had undergone prior IBD-related surgery, respectively. The mean age at conception was 34.10 years in the surgical UC group and 30.30 years in the surgical CD group. Mode of delivery: C-section rates were higher in post-surgical compared to non-surgical UC patients (70% vs. 30.4%, p = 0.02). Similar numbers of C-sections were performed emergently in the surgical compared to non-surgical UC group (10% vs. 18%, p = 0.53). Comparatively, there was no significant difference in C-section rates in post -surgical compared to non-surgical CD mothers (50% vs. 40%, p = 0.44), with 13% performed emergently in both groups. Maternal outcomes: Gestational diabetes developed in 10% of surgical UC and 4.5% of surgical CD patients. Premature rupture of membranes developed in 10% of surgical UC and 9.1% of surgical CD patients. There was no difference in pre-eclampsia rates in the surgical and non-surgical CD groups (9.1% vs 13.2%, p = 0.64). Neonatal outcomes: There was no significant difference in pre-term birth rates in post-surgical compared to non-surgical UC mothers (10% vs. 15.2%, p = 0.67) or in surgical compared to non-surgical CD mothers (13.6% vs. 5.1%, p = 0.29). Neonatal Intensive Care Unit (NICU) requirements were higher in infants born to post-surgical CD compared to non-surgical CD mothers (18.2% vs. 2.7%, p = 0.04). More low birth weight (LBW) infants were born to post-surgical CD vs non-surgical CD mothers (13.6% vs. 0%, p = 0.02). Conclusions Women with IBD who have had prior IBD-related surgery may be at increased risk of developing adverse gestational and neonatal outcomes. Women with surgical UC have an increased incidence of Cesarean delivery. Funding Agencies None

Review of the immune mechanisms of preeclampsia and the potential of immune modulating therapy

Successful pregnancy relies on maternal immunologic tolerance mechanisms limit maladaptive immune responses against the semi-allogeneic fetus and placenta and support fetal growth. Preeclampsia is a common disorder of pregnancy that affects 4–10% of pregnancies and is a leading cause of maternal and neonatal morbidity and mortality. Preeclampsia clinically manifests as maternal hypertension, proteinuria, and progressive multi-organ injury likely triggered by hypoxic injury to the placenta, resulting in local and systemic anti-angiogenic and inflammatory factor production. Despite the steady rising rates of preeclampsia in the United States, effective treatment options are limited to delivery, which improves maternal status often at the cost of prematurity in the newborn. Preeclampsia also increases the lifelong risk of cardiovascular disease for both mother and infant. Thus, identifying new therapeutic targets is a high priority area to improve maternal, fetal, and infant health outcomes. Immune abnormalities in the placenta and in the maternal circulation have been reported to precede the clinical onset of disease. In particular, excessive systemic and placental complement activation and impaired adaptive T cell tolerance with Th1/Th2/Th17/Treg imbalance has been reported in humans and in animal models of preeclampsia. In this review, we focus on the evidence for the immune origins of preeclampsia, discuss the promise of immune modulating therapy for prevention or treatment, and highlight key areas for future research.

1051 Preeclampsia prevention with 81mg versus 162mg of aspirin prophylaxis based upon timing of initiation

Though an aspirin dose of 81mg is recommended for preeclampsia prevention, evidence suggests that doses higher than 100mg and/or initiation prior to 16 weeks confers improved prophylaxis and benefit. The goal of this study is to determine how aspirin dose alongside timing of initiation affects preeclampsia rates. This is a retrospective cohort analysis of pregnancies treated with prophylactic aspirin initiated prior to 20 weeks of gestation between July 2016 and December 2019. All patients who met ACOG risk classifications for aspirin prophylaxis were started either on 81 or 162 mg of aspirin. Outcomes reviewed included preeclampsia rates among pregnancies using 81 versus 162mg of aspirin, initiated prior to 14 weeks ( first trimester) versus 14-20 weeks of gestation (second trimester). Variables were examined using logistic regression. A total of 163 pregnancies were examined. In Figure 1, with 81 mg aspirin dose, timing of initiation did not significantly affect preeclampsia rates (34.2% first trimester initiation vs 22.7% second trimester initiation). However, with higher dosing, preeclampsia rates with first trimester initiation was lower in comparison to second trimester initiation (17.9% vs 24.6%). Logistic regression analysis shows significant (p<0.001) risk reduction with earlier initiation in only the 162mg aspirin cohort, with an average 1.6% decrease of preeclampsia risk with each week of aspirin use prior to 20 weeks of gestation. Analogous significant results were not found in the 81mg aspirin cohort. This study suggests first trimester initiation of a higher dose of aspirin confers improved preeclampsia prophylaxis among high risk mothers; future studies should seek strategies to improve the prophylactic potential of aspirin through exploration of optimal dosing and gestational age for initiation.